Contribución del personal sanitario al insuficiente control de la hipertension arterial en consultas de atención primaria

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Departamento de Medicina. Fecha de lectura: 24-Octubre-200

Nuevos Requisitos y Avances en Seguridad Pasiva en Autobuses y Autocares: Situación Actual y Necesidades

La seguridad pasiva en los autobuses y autocares viene marcada fundamentalmente por la aparición de reglamentación que impone requisitos a las estructuras y sistemas de retención de estos vehículos para garantizar la seguridad de sus ocupantes. En los últimos años se han realizado numerosos avances en seguridad que han conllevado (y siguen arrastrando) la necesidad de estudios de investigación para determinar qué requisitos hay que imponer sobre los mismos (niveles de esfuerzos, deformación, energía…). En la reglamentación Europea destacan: - Seguridad ante impactos frontales, con la incorporación de cinturones de seguridad, que ha conllevado un gran esfuerzo y modificaciones tanto a los fabricantes de asientos, carroceros como a las oficinas técnicas. - Seguridad ante vuelco, con el aumento en los requisitos de resistencia estructural a vuelco, que está suponiendo hoy por hoy nuevas soluciones técnicas para las carrocerías. El trabajo presenta un resumen de la situación actual así como de los principales estudios prelegislativos realizados por el INSIA-UPM para determinar que requisitos deben cumplir estos vehículos, en función de la accidentalidad existente, fundamentalmente a vuelco y ante impacto frontal. Se destacan también las carencias existentes actualmente. Por ejemplo tenemos reglamentación que verifique la resistencia estructural a vuelco y la correcta retención de los pasajeros ante impacto frontal. Pero no hay nada que garantice la resistencia estructural ante impacto frontal ni la correcta retención en caso de vuelco. Este trabajo presenta algunas ideas en estos aspectos (cálculos y ensayos)

Preparation of palladium-supported periodic mesoporous organosilicas and their use as catalysts in the Suzuki cross-coupling reaction

Three periodic mesoporous materials, i.e., two organosilicas with either ethylene or phenylene bridges and one silica, have been used as supports for Pd nanoparticles. All Pd-supported samples (1.0 wt%) were prepared by the incipient wetness method and subsequently reduced in an H2 stream at 200 °C. Both hydrogen chemisorption and temperature programmed reduction experiments revealed significant differences depending on the support. Pd2+ species were more reducible on the mesoporous organosilicas than on their silica counterpart. Also, remarkable differences on the particle morphology were observed by transmission electron microscopy. All Pd-supported samples were active in the Suzuki cross-coupling reaction between bromobenzene and phenylboronic acid

Working memory over a six-year period in young binge drinkers

Adolescence and early adulthood are periods of particular vulnerability to the neurotoxic effects of alcohol. Young people with alcohol-use disorders display deficits in working memory (WM). This function is supported by the prefrontal cortex, a late-maturing brain region. However, little is known about the progression of cognitive dysfunctions associated with a binge-drinking (BD) pattern of alcohol consumption among non-clinical adolescents. The objective of this study was to analyze the relationship between BD trajectory and WM in university students. An initial sample of 155 male and female first-year university students was followed prospectively over 6 years. The participants were classified as stable non-BDs, stable BDs, and ex-BDs, according to the third item of the Alcohol Use Disorders Identification Test (AUDIT). WM was assessed using the Self-Ordered Pointing Task. Generalized linear mixed models were applied. The results showed that stable BDs committed more total perseverative errors and showed a lower WM span in the difficult blocks than stable non-BDs. Difficulties in WM span showed some improvement, whereas perseveration errors remained constant throughout the follow-ups in the stable BDs. There were no significant differences between ex-BDs and non-BDs. In conclusion, stable BD is associated with WM deficits, particularly perseverations and low WM span in demanding trials, when compensatory mechanisms may no longer be successful. The partial improvement in WM span may support the notion of a neuromaturational delay, whereas the temporal stability of perseveration deficits may reflect either neurotoxic effects of alcohol or premorbid characteristics. Abandoning the BD pattern of alcohol consumption may lead to partial recoveryThe study was supported by grants from the Spanish Ministerio de Ciencia e Innovación, Plan Nacional (PSI2011-22575) and Plan Nacional Sobre Drogas (exp 2010/134) and (exp 2015/034). Carina Carbia was supported by the FPU program (FPU13/04569) of the Spanish Ministerio de EducaciónS

Diseño y desarrollo de un vehículo híbrido multipropósito y ligero para servicios urbanos

La necesidad de reducir las emisiones de CO2 ha obligado a los fabricantes de automóviles a mejorar el consumo de combustible de sus vehículos y a desarrollar arquitecturas híbridas de propulsión, tanto gasolina – eléctrico como con pila de combustible. Aunque la configuración de este tipo de vehículos híbridos puede ser similar a la de los tradicionales de motor térmico, nuevos componentes implican nuevas posibilidades de reconfigurar el sistema de propulsión, diferentes distribuciones de volúmenes y pesos, de manera que se puede mejorar su dinámica y sus prestaciones. El origen del proyecto presentado es la respuesta del INSIA a las necesidades de una empresa de equipamiento urbano de tener un vehículo híbrido para aplicaciones ligeras. Está diseñado para equipar diferentes configuraciones híbridas, tanto de gasolina como de pila de combustible y, por petición del cliente, dispone de paneles solares en el techo de la cabina y de la caja de carga

Analysis of incidence, risk factors and clinical outcome of thromboembolic and bleeding events in 431 allogeneic hematopoietic stem cell transplantation recipients

This is an open-access paper.-- et al.Allogeneic hematopoietic stem cell transplantation recipients have an increasing risk of both hemorrhagic and thrombotic complications. However, the competing risks of two of these life-threatening complications in these complex patients have still not been well defined. We retrospectively analyzed data from 431 allogeneic transplantation recipients to identify the incidence, risk factors and mortality due to thrombosis and bleeding. Significant clinical bleeding was more frequent than symptomatic thrombosis. The cumulative incidence of a bleeding episode was 30.2% at 14 years. The cumulative incidence of a venous or arterial thrombosis at 14 years was 11.8% and 4.1%, respectively. The analysis of competing factors for venous thrombosis revealed extensive chronic graft-versus-host disease to be the only independent prognostic risk factor. By contrast, six factors were associated with an increased risk of bleeding; advanced disease, ablative conditioning regimen, umbilical cord blood transplantation, anticoagulation, acute III-IV graft-versus-host disease, and transplant-associated microangiopathy. The development of thrombosis did not significantly affect overall survival (P=0.856). However, significant clinical bleeding was associated with inferior survival (P<0.001). In allogeneic hematopoietic stem cell transplantation, significant clinical bleeding is more common than thrombotic complications and affects survival.Peer Reviewe

Outcomes of abdominal surgery in patients with liver cirrhosis

Patients suffering from liver cirrhosis (LC) frequently require non-hepatic abdominal surgery, even before liver transplantation. LC is an important risk factor itself for surgery, due to the higher than average associated morbidity and mortality. This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors, such as coagulopathy, poor nutritional status, adaptive immune dysfunction, cirrhotic cardiomyopathy, and renal and pulmonary dysfunction, which all lead to poor outcomes. Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery. In the emergency setting, with the presence of decompensated LC, alcoholic hepatitis, severe/advanced LC, and significant extrahepatic organ dysfunction conservative management is preferred. A multidisciplinary, individualized, and specialized approach can improve outcomes; preoperative optimization after risk stratification and careful management are mandatory before surgery. Laparoscopic techniques can also improve outcomes. We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before, during, and after surgery

C-Reactive Protein and Serum Albumin Ratio: A Feasible Prognostic Marker in Hospitalized Patients with COVID-19

Background: C-reactive protein (CRP) and albumin are inflammatory markers. We analyzed the prognostic capacity of serum albumin (SA) and CRP for an outcome comprising mortality, length of stay, ICU admission, and non-invasive mechanical ventilation in hospitalized COVID-19 patients. (2) Methods: We conducted a retrospective cohort study based on the Spanish national SEMI-COVID-19 Registry. Two multivariate logistic models were adjusted for SA, CRP, and their combination. Training and testing samples were used to validate the models. (3) Results: The outcome was present in 41.1% of the 3471 participants, who had lower SA (mean [SD], 3.5 [0.6] g/dL vs. 3.8 [0.5] g/dL; p < 0.001) and higher CRP (108.9 [96.5] mg/L vs. 70.6 [70.3] mg/L; p < 0.001). In the adjusted multivariate model, both were associated with poorer evolution: SA, OR 0.674 (95% CI, 0.551-0.826; p < 0.001); CRP, OR 1.002 (95% CI, 1.001-1.004; p = 0.003). The CRP/SA model had a similar predictive capacity (honest AUC, 0.8135 [0.7865-0.8405]), with a continuously increasing risk and cutoff value of 25 showing the highest predictive capacity (OR, 1.470; 95% CI, 1.188-1.819; p < 0.001). (4) Conclusions: SA and CRP are good independent predictors of patients hospitalized with COVID-19. For the CRP/SA ratio value, 25 is the cutoff for poor clinical course